News from Bioethics.com

(IEEE Spectrum) – As COVID-19 sweeps through the planet, a number of researchers have advocated the use of digital contact tracing to reduce the spread of the disease. The controversial technique can be effective, but can have disastrous consequences if not implemented with proper privacy checks and encryption. Ramesh Raskar, an associate professor at MIT Media Lab, and his team have developed an app called Private Kit: Safe Paths that they say can do the job while protecting privacy. The software could get integrated into a new, official WHO app touted as the “Waze for COVID-19.” IEEE Spectrum spoke with Raskar to better understand the risks and benefits of digital contact tracing.

(AMA) – The COVID-19 pandemic has demanded of U.S. physicians, medical educators and policymakers to ask many difficult ethical questions. Among them: What is the physician’s duty to show up for work during a deadly outbreak? When is it appropriate to prescribe drugs that haven’t been approved to treat COVID-19? And when the supply of life sustaining equipment like ventilators is severely limited, which patients should get priority? The AMA has created an ethics resource, “AMA Code of Medical Ethics: Guidance in a pandemic,” that offers guidance to these questions and others relevant to the unfolding public health emergency. Drawing on numerous opinions from the Code, this resource includes discussions of ethical challenges particular to the COVID-19 response.

(Science) – COVID-19, caused by the new pandemic coronavirus, is strangely—and tragically—selective. Only some infected people get sick, and although most of the critically ill are elderly or have complicating problems such as heart disease, some killed by the disease are previously healthy and even relatively young. Researchers are now gearing up to scour the patients’ genomes for DNA variations that explain this mystery. The findings could be used to identify those most at risk of serious illness and those who might be protected, and they might also guide the search for new treatments.

(Reuters) – In New York, a mother-to-be faces childbirth without her husband. In Texas, hundreds of women seeking abortions are turned away. Across the country, women are facing postponed mammograms and suspended fertility treatments. The global coronavirus pandemic has infected at least 73,000 people and killed more than 1,000 in the United States as of Thursday afternoon. As U.S. authorities have told residents to remain at home and limited all but essential healthcare, the directives aimed at saving lives have hit women particularly hard, healthcare providers and patients said.

(CNN) – As the coronavirus pandemic continues to sweep the United States, some hospitals are considering whether to make changes to policies and practices when it comes to do-not-resuscitate situations. Such conversations come as hospitals brace for a surge of patients, despite dwindling supplies of personal protective equipment for doctors and ventilators for seriously ill patients.

(Kaiser Health News) – Getting heath care by phone or video conferencing has been around for several decades, but the outbreak of coronavirus has led to an increase in telemedicine use as never seen before, according to health systems and provider groups across the country. Millions of Americans are seeking care by connecting with a doctor electronically, many for the first time. Health systems, insurers and physician groups said it allows people to practice social distancing while reducing the spread of the disease and protecting health workers.

(Reuters) – Nurses in Kenya’s capital and at least two towns have launched protests or refused to treat suspected coronavirus patients because the government has not given them enough protective gear or training, a medical union chief said. Only a fraction of Kenya’s estimated 100,000 healthcare workers had received any instruction in how to protect themselves, Seth Panyako, the secretary general of the Kenya National Union of Nurses, told Reuters.

(The New York Times) – While the disease itself does not necessarily place patients at high risk for contracting the virus, they and their caregivers face a range of special challenges. Dementia patients are typically very sensitive to changes in routine and often require a great deal of hands-on care, both factors that are hard to manage now. Family members who usually rely on day care programs or visiting caregivers may be finding themselves with full-time responsibilities, while others whose loved ones are in facilities are unable to visit them now.

(Undark) – A ventilator is designed and can be set for only one patient at a time. Since two patients are unlikely to require oxygen at the same amount and pressure, one might get too little oxygen while the other receives too much, injuring their lungs either way. Also, the air tubes might distribute contaminants between patients. Reflecting these concerns, one major ventilator manufacturer and the American Association for Respiratory Care both discourage hospitals from connecting machines to multiple patients. Some hospitals are reluctant to try it under any circumstances and are looking for other backup plans.

(Nature) – As hundreds of millions of people, maybe billions, avoid social contact to spare themselves and their communities from coronavirus, researchers are discussing a dramatic approach to research that could help end the pandemic: infecting a handful of healthy volunteers with the virus to rapidly test a vaccine. Many scientists see a vaccine as the only solution to the pandemic. Clinical safety trials began this month for one candidate vaccine, and others will soon follow. But one of the biggest hurdles will be showing that a vaccine works. Typically, this is done through large phase III studies, in which thousands to tens of thousands of people receive either a vaccine or a placebo, and researchers track who becomes infected in the course of their daily lives.

(The New York Times) – Can blood from coronavirus survivors help other people fight the illness? Doctors in New York will soon be testing the idea in hospitalized patients who are seriously ill. Blood from people who have recovered can be a rich source of antibodies, proteins made by the immune system to attack the virus. The part of the blood that contains antibodies, so-called convalescent plasma, has been used for decades to treat infectious diseases, including Ebola and influenza.

(New York Times) – How do doctors and hospitals decide who gets potentially lifesaving treatment and who doesn’t? A lot of thought has been given to just such a predicament, well before critical shortages from the coronavirus pandemic. “It would be irresponsible at this point not to get ready to make tragic decisions about who lives and who dies,” said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado.

(Nature) – Scientists are rushing to launch clinical trials of experimental vaccines against the coronavirus, and treatments for COVID-19. But as hospitals brace for an onslaught of critically ill patients and laboratories worldwide are disrupted, researchers have had to shelve clinical trials of therapies for other illnesses. “We’re going to see a nearly complete close-down in clinical research,” says Tim Dyer, chief executive of Addex Therapeutics, a biotechnology company based in Geneva, Switzerland. “The health-care systems will simply be overloaded.” On 18 March, Addex announced that it would delay the start of a clinical trial to treat involuntary movements in people with Parkinson’s disease.

(Reuters) – Outside a Paris retirement home on Wednesday, a director rushed out and told the man delivering a coffin to use a side entrance, away from prying eyes. The coffin, one of three brought the same morning, came hours after officials said 13 elderly residents had died in the home since March 11 and that more than 80 others were believed to have the coronavirus.

(NPR) – The Spanish military has found older residents of some care homes “completely abandoned” and even “dead in their beds,” Defense Minister Margarita Robles said in a television interview on Monday. They were found as soldiers disinfected and provided emergency health care services this week to residential homes across the country. Robles did not give an exact figure for the number of dead bodies found by Spanish soldiers. With more than 39,000 confirmed cases of COVID-19 and 2,800 deaths as of Tuesday, Spain is the second hardest-hit country in Europe.

(UPI) – New York, “ground zero” for the U.S. coronavirus outbreak, is taking the lead on drug testing, with trials beginning this week on three drugs believed to have potential for treatment. Trials to assess the efficacy and safety of the anti-malaria drug chloroquine, its sister agent hydroxychloroquine and the antibiotic azithromycin will join trials of other drugs going on globally, including tests of an HIV drug and an antiviral.

(The New York Times) – Groups representing people with disabilities on Monday challenged a plan that would guide hospitals in Washington State dealing with the coronavirus in the event that they do not have enough lifesaving resources for all the patients who need them. The triage care plan could result in end-of-life decisions that disadvantage those with disabilities, said David Carlson, the director of advocacy at Disability Rights Washington. The group’s complaint calls for the federal government to quickly intervene to investigate, issue findings and make sure that doctors and hospitals do not discriminate against people with disabilities when making treatment decisions.

(The New York Times) – Health workers are urging efforts to suppress the outbreak and expand medical capacity so that rationing will be unnecessary. But if forced, they ask, how do they make the least terrible decision? How do they minimize deaths? Who even gets to decide, and how are their choices justified to the public? Medical providers are considering these questions based on what first occurred in China, where many sick patients were initially turned away from hospitals, and now is unfolding in Italy, where overwhelmed doctors are withholding ventilators from older, sicker adults so they can go to younger, healthier patients.

(Kaiser Health News) – In the same week that physicians at the University of California-San Francisco medical center were wiping down and reusing protective equipment like masks and gowns to conserve resources amid a surge of COVID-19 patients, 90 miles away teams of doctors at UC Davis Medical Center were fully suited up performing breast augmentations, hip replacements and other elective procedures that likely could have been postponed. Across the nation, hospitals, nurses and physicians are sending out desperate pleas for donations of personal protective gear as supplies dwindle in the regions that have emerged as hot spots for the fast-spreading new coronavirus. The Centers for Medicare & Medicaid Services, the Surgeon General and the American College of Surgeons (ACS) have urged hospitals to curtail non-urgent elective procedures to preserve equipment.

(The New York Times) – Medical leaders in Washington State, which has the highest number of coronavirus deaths in the country, have quietly begun preparing a bleak triage strategy to determine which patients may have to be denied complete medical care in the event that the health system becomes overwhelmed by the coronavirus in the coming weeks. Fearing a critical shortage of supplies, including the ventilators needed to help the most seriously ill patients breathe, state officials and hospital leaders held a conference call on Wednesday night to discuss the plans, according to several people involved in the talks.

(Bloomberg) – The coronvirus pandemic prompted the FDA to relax some clinical trial requirements, so last-minute decisions to safeguard research participants won’t trigger the agency’s enforcement arm. The Food and Drug Administration issued guidance Wednesday to help drug and device companies manage their clinical trials during the Covid-19 outbreak, the disease caused by the novel coronavirus SARS-CoV-2. Ongoing clinical trials face disruptions such as site closures, quarantines, travel limitations, and supply chain issues that could lead to shortages of the investigational drug or device, the agency noted.

(USA Today) – Government representatives recently ordered infectious disease experts in Seattle not to test previously collected nasal swab samples for coronavirus (COVID-19) in order to assess the current outbreak. The researchers did it anyway, in what has become an important test case for the way we regulate research and diagnostic testing during a global pandemic. Dr. Helen Y. Chu, a physician researcher at the University of Washington School of Medicine, had been collecting nasal swabs from research participants in the Seattle Flu Study with the goal of being able to better detect and control the spread of flu.

(ProPublica) – Over the next three months, nearly a million women in the United States will give birth to nearly a million babies — a huge influx of mostly healthy, highly vulnerable patients into a hospital system that’s about to come under unprecedented strain. Pregnant women, not surprisingly, are anxious. Those in their third trimester, looking to deliver during an epidemic, are close to frantic.

(Kaiser Health News) – More than half the counties in America have no intensive care beds, posing a particular danger for more than 7 million people who are age 60 and up ? older patients who face the highest risk of serious illness or death from the rapid spread of COVID-19, a Kaiser Health News data analysis shows.

(STAT News) – Over the next week, at least four startups are launching the first at-home tests for Covid-19. The companies, whose tests have been mostly greenlit — but not approved in the conventional sense — by the U.S. Food and Drug Administration under new guidelines instituted for the coronavirus crisis, aim for their diagnostics to offer some certainty to people who have up until now been unable to get tested as a result of the shortage of test kits. Most of the companies have put their other efforts on hold to focus on coronavirus.